Severe Stage Research Articles

Epidemiology of cardiogenic shock using the Shock Academic Research Consortium (SHARC) consensus definitions.

The Shock Academic Research Consortium (SHARC) recently proposed pragmatic consensus definitions to standardize classification of cardiogenic shock (CS) in registries and clinical trials. We aimed to describe contemporary CS epidemiology using the SHARC definitions in a cardiac intensive care unit (CICU) population. The Critical Care Cardiology Trials Network (CCCTN) is a multinational research network of advanced CICUs coordinated by the TIMI Study Group (Boston, MA). Cardiogenic shock was defined as a cardiac disorder resulting in SBP < 90 mmHg for ≥30 min [or the need for vasopressors, inotropes, or mechanical circulatory support (MCS) to maintain SBP ≥ 90 mmHg] with evidence of hypoperfusion. Primary aetiologic categories included acute myocardial infarction-related CS (AMI-CS), heart failure-related CS (HF-CS), and non-myocardial (secondary) CS. Post-cardiotomy CS was not included. Heart failure-related CS was further subcategorized as de novo vs. acute-on-chronic HF-CS. Patients with both cardiogenic and non-cardiogenic components of shock were classified separately as mixed CS. Of 8974 patients meeting shock criteria (2017-23), 65% had isolated CS and 17% had mixed shock. Among patients with CS (n = 5869), 27% had AMI-CS (65% STEMI), 59% HF-CS (72% acute-on-chronic, 28% de novo), and 14% secondary CS. Patients with AMI-CS and de novo HF-CS were most likely to have had concomitant cardiac arrest (P < 0.001). Patients with AMI-CS and mixed CS were most likely to present in more severe shock stages (SCAI D or E; P < 0.001). Temporary MCS use was highest in AMI-CS (59%). In-hospital mortality was highest in mixed CS (48%), followed by AMI-CS (41%), similar in de novo HF-CS (31%) and secondary CS (31%), and lowest in acute-on-chronic HF-CS (25%; P < 0.001). SHARC consensus definitions for CS classification can be pragmatically applied in contemporary registries and reveal discrete subpopulations of CS with distinct phenotypes and outcomes that may be relevant to clinical practice and future research.

Different right ventricular mechanics in atrial and ventricular secondary tricuspid regurgitation and their prognostic role. A multicentric three-dimensional echocardiography study

Abstract Background/Introduction Secondary tricuspid regurgitation (STR) can develop from markedly different etiologies. Both progressive dilation and dysfunction of the right atrium (atrial phenotype, ASTR), and adverse right ventricular (RV) remodeling (ventricular phenotype, VSTR) may result in STR. RV function is a major determinant of outcome in patients with STR. However, data about how RV function adapts to ASTR and VSTR are scarce, and the prognostic implications of RV mechanics in ASTR and VSTR remain to be clarified. Purpose Accordingly, we aimed to investigate the RV mechanical patterns in ASTR and VSTR and to examine their prognostic role using three-dimensional (3D) echocardiography. Methods We enrolled 192 patients with STR (60% women) who underwent clinically indicated transthoracic echocardiography in a multicentric prospective observational study. The primary outcome was defined as a composite of heart failure hospitalization or cardiac death. STR etiology was assessed based on the TVARC criteria (ventricular STR n=134, atrial STR n=58). STR severity was categorized using STR effective regurgitant orifice area according to current guidelines. We assessed RV function by measuring the tricuspid annular plane systolic excursion (TAPSE) by M-mode echocardiography and RV ejection fraction (EF) by 3D echocardiography. In addition, we imported the 3D RV meshes into the ReVISION software package (Argus Cognitive, Inc, Lebanon, USA) to quantify the relative contribution of the longitudinal (LEFi), radial (REFi), and anteroposterior motion components (AEFi) to total RV EF. Results ASTR and VSTR patients had comparable TAPSE (17±5 mm vs. 18±5 mm, p=0.10), while RV EF was significantly higher in ASTR (54±7% vs. 47±10% p&amp;lt;0.001). Although LEFi (0.37±0.08 vs. 0.38±0.10, p=0.95) and AEFi (0.45±0.08 vs. 0.44±0.11, p=0.53) were comparable between ASTR and VSTR, REFi was significantly lower in VSTR (0.52±0.09 vs. 0.47±0.12, p&amp;lt;0.01). RF EF was comparable among STR severity grades (mild vs. moderate vs. severe: 50±11 vs. 49±9 vs. 50±10%, respectively, p=0.85). Conversely, LEFi was significantly higher in mild and moderate STR vs severe STR (0.39±0.08 vs. 0.39±0.09 vs. 0.35±0.10, respectively, p=0.04). Using multivariable Cox regression based on variables significant in the univariate analysis, REFi was a significant independent predictor of outcome in the entire cohort (hazard ratio: 0.978 [CI, 0.959-0.999], p= 0.037). Conclusions Using 3D echocardiographic assessment, ASTR and VSTR patients demonstrated significant differences in the RV mechanical pattern, with a lower contribution of the radial contraction in the case of ventricular STR etiology. While RV EF was comparable between STR severity grades, the relative importance of the longitudinal motion significantly differed. Notably, the relative contribution of radial motion to RV function demonstrated independent prognostic value in patients with STR.RV mechanics in STR severity stages

A New Ray of Hope in the Treatment of Seasonal Hyperacute Panuveitis: Could Intravitreal Triple Combination Therapy of an Antibiotic with Dual Steroids Play a Pivotal Role?

ABSTRACT Introduction Seasonal Hyperacute Panuveitis (SHAPU) is a blinding disease in Nepal with unknown aetiology. Henceforth, we proposed to study the treatment outcome of a triple intravitreal combination therapy of dual steroids triamcinolone (long-acting steroid) and dexamethasone (short-acting steroid) along with antibiotic moxifloxacin for patients with severe stage of SHAPU. Methods A prospective study was conducted among the SHAPU patients presenting in severe stages during the September to December 2023 outbreak. Intravitreal injection of 4-mg preservative-free triamcinolone acetonide (4 mg/0.1 ml) with intravitreal dexamethasone injection (0.4 mg/0.1 ml) and 0.5 mg/0.1 ml of moxifloxacin was given in the operating theatre. Best corrected visual acuity, intraocular pressure measurements, vitreous haze and fundus evaluation, were assessed to determine the treatment outcome on examination on day 7 and day 30 following intravitreal combination therapy. Result A total of 6 patients (2 female and 4 male) were enrolled. At presentation, the mean BCVA was 2.40 ± 0.30 logMAR, mean intraocular pressure was 12.8 mmHg and vitreous haze was 4+ haze in all cases. The evaluation on the 7th day and 30th after injection showed significant improvement in BCVA (p value = 0.039; p value = 0.040, respectively). The change in the IOP at day 7 (p value = 0.85) was insignificant. However, the IOP change was significant at day 30 (p value = 0.5). Similarly, there was a marked reduction in the vitreous haze with better fundus visibility after treatment. Conclusion This study depicted that steroids prevent the dreaded complication of hypotony due to ciliary shutdown by combating severe inflammation, thus adding new hope to the armamentarium of SHAPU management.

Automated CT-based Decoupling of the Effects of Airway Narrowing and Wall Thinning on Airway Counts in Chronic Obstructive Pulmonary Disease.

We examine pathways of airway alteration due to wall thinning, narrowing, and obliteration at different COPD severity stages using CT-derived airway metrics. Ex-smokers (N = 649; age mean±std: 69 ± 6years; 52% male) from the COPDGene Iowa cohort (September 2013-July 2017) were studied. Total airway count (TAC), peripheral TAC beyond 7th generation (TACp), and airway wall thickness (WT) were computed from chest CT scans using previously validated automated methods. Causal relationships among demographic, smoking, spirometry, COPD severity, airway counts, WT, and scanner variables were analyzed using causal inference techniques including direct acyclic graphs (DAGs) to quantitatively assess multi-pathway alterations of airways in COPD. TAC, TACp, and WT were significantly lower (p < 0.0001) in mild, moderate, and severe COPD compared to the preserved lung function group. TAC (TACp) losses attributed to narrowing and obliteration of small airways were 4.59, 13.29, and 32.58% (4.64, 17.82, and 45.51%) in mild, moderate, and severe COPD, while the losses attributed to wall thinning were 8.24, 17.01, and 22.95% (12.79, 25.66, and 33.95%) in respective groups. Different pathways of airway alteration in COPD are observed using CT-derived automated airway metrics. Wall thinning is a dominant contributor to both TAC and TACp loss in mild and moderate COPD while narrowing and obliteration of small airways is dominant in severe COPD. This automated CT-based study shows that wall thinning dominates airway alteration in mild and moderate COPD while narrowing and obliteration of small airways leads the alteration process in severe COPD.

Counting the costs: understanding the extra costs of living with disability in Indonesia to advance inclusive policies within the SDG framework

The Sustainable Development Goals (SDGs) are a multidimensional framework for monitoring progress on disability inclusion over time and among countries where reliable, disability disaggregated data is available. However, the SDGs alone do not provide insights into the causes of the social and economic disparities that people with disabilities face or offer specific policy solutions to alleviate them. This paper highlights the extra costs of living with disability in Indonesia to advance the country's commitment to further the rights of people with disabilities. It utilizes three primary estimation methods, combining an analyses of national survey data with primary data from interviews and focus group discussions. Findings reveal significant and varying costs based on disability type, severity and life cycle stages. It also highlights the unaffordability of these costs for most individuals with disabilities and their families. Leveraging these estimates, the paper proposes ‘disability concessions’ aligned with Indonesia's legal framework on disability inclusion, aiming to alleviate financial burdens through discounts across health, education, utilities and transportation. By contributing to methodological approaches in understanding extra costs of living with disability inclusion in emerging country context and promoting discussions on leveraging the results for disability inclusive policymaking, this paper supplements the SDG framework to foster disability inclusion.

Costs of Illness for Huntington's Disease: A Systematic Review.

Huntington's disease (HD) is associated with significant financial burden for patients and payers. The objective was to identify and quantify costs of HD by stage of disease progression. A systematic search of Medline, Embase, Scopus, and Cochrane Library was used to identify types of costs that are frequently reported for individuals diagnosed with HD and to quantify those costs across early, middle, and late stages of HD. Full-text, original research articles were included if they reported costs specific to HD burden. To standardize stage-level costs, Shoulson Fahn and Barthel Index scores were combined to estimate the cost for early, middle-, and late-stage HD. A total of 692 abstracts were identifie,d and following abstract screening, a total of 80 full-text articles were reviewed for inclusion. Only five studies were included for extraction and synthesis including three from the USA, one from the United Kingdom (UK), and one from Peru. Annual inpatient, outpatient, drug costs, and caregiving costs all increased substantially as disease progressed. Outpatient costs were approximately 2.5 times greater than inpatient costs for early and middle stages of HD. Among all the costs associated with HD, annual caregiver cost emerges as the most significant costs in the economic burden of HD, ranging from a minimum of $6041 for early stage to a maximum of $133,200 for late-stage HD. Significant variation was observed across studies, especially comparing costs observed in Peru with the USA and UK. Outpatient costs exceed inpatient costs, especially in early and middle stages, underscoring the importance of outpatient care. All costs seem to rise rapidly, in a nonlinear fashion, as patients advance to later stages. While only two studies reported caregiver burden, these costs were significanly higher in the most severe stage, where patients were completely dependent on a caregiver. This review highlights the complexity of cost assessment in HD and underscores the need for consistent methods and further research to guide effective policy actions.

Does the presence or absence of preoperative lower extremity neurologic symptoms influence postoperative clinical outcome in patients with cervical intradural extramedullary tumors?: a single-center retrospective comparative study.

Retrospective comparative study OBJECTIVES: To investigate whether the presence or absence of preoperative lower extremities neurological symptoms (LENS) influences clinical outcomes following tumor resection in patients with cervical intradural extramedullary (IDEM) tumors. The single institution in Japan. Ninety-two patients with cervical IDEM tumors requiring surgical resection were included. Based on the degree of preoperative LENS assessed using the modified McCormick scale (MMCS), patients were categorized into LENS (-) and (+) groups. Demographic and surgical characteristics were compared between both groups. There were no significant differences observed in sex, tumor location, tumor size, surgical time, estimated blood loss, approach for tumorectomy, or tumor histopathology between the two groups. Additionally, the overall surgical outcomes were favorable for both groups. At the final follow-up, 91.1% of the patients in the LENS (+) group were able to walk without support. Improvement in LENS was observed after surgery in most patients with preoperative MMCS II-IV, but it persisted in approximately 40% of patients with preoperative MMCS V. In the LENS (+) group, there were no significant differences in demographic or surgical data between the patients with MMCS I and II-III at the final follow-up. Regardless of the presence or absence of preoperative LENS, clinical improvement was observed after tumor resection in most patients with cervical IDEM tumors. These findings suggest that neurological status is likely to improve sufficiently if tumor resection is performed before preoperative LENS deteriorates to an extremely severe stage as MMCS V.

Association of RDoC dimensions with post-mortem brain transcriptional profiles in Alzheimer's Disease.

Neuropsychiatric symptoms are common in people with Alzheimer's disease (AD) across all severity stages. Their heterogeneous presentation and variable temporal association with cognitive decline suggest shared and distinct biological mechanisms. We hypothesized that specific patterns of gene expression associate with distinct NIMH Research Domain Criteria (RDoC) domains in AD. Post-mortem bulk RNAseq on the insula and anterior cingulate cortex from 60 brain donors representing the spectrum of canonical AD neuropathology combined with natural language processing approaches based on the RDoC Clinical Domains. Distinct sets of >100 genes (p FDR <0.05) were specifically associated with at least one clinical domain (Cognitive, Social, Negative, Positive, Arousal). In addition, dysregulation of immune response pathways was shared across domains and brain regions. Our findings provide evidence for distinct transcriptional profiles associated with RDoC domains suggesting that each dimension is characterized by specific sets of genes providing insight into the underlying mechanisms.

Long Non-Coding RNAs in Non-Alcoholic Fatty Liver Disease; Friends or Foes?

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a range of conditions that start with the accumulation of fat in the liver (hepatic steatosis) and can progress to more severe stages like steatohepatitis (NASH) and fibrosis without drinking alcohol. Environmental and genetic variables both contribute to MAFLD's development, with various biological processes and mediators involved at every phase. Long non-coding RNAs (lncRNAs) are a class of RNA molecules that are not translated into protein and are over 200 nucleotides long. They can impact genes that encode protein by controlling transcriptional and post-transcriptional procedures. Dysregulation of lncRNA has been connected to several liver diseases, including MAFLD. Recent research has linked lncRNAs to MAFLD pathology in both patients and animal models. However, the roles of most lncRNAs in MAFLD pathology are still not well recognized. This review provides a comprehensive catalog of recently reported lncRNAs in the pathogenesis of MAFLD and summarizes the current knowledge of lncRNAs usage as therapeutic strategies in MAFLD, the most common liver disease. Collectively, lncRNA's targeting could potentially offer a therapeutic approach by modulating MAFLD.

Elucidating Mechanisms of Chronic Traumatic Encephalopathy CTE A Systematic Review of the Literature

Background : Chronic traumatic encephalopathy CTE is a progressive neurodegeneration that can be widely distributed throughout the brain due to accumulation of neuropathologic lesions following exposure to repetitive head impact (RHI) causing concussions or sub-concussive traumatic brain injury (TBI). Populations at risk include military personnel and contact sports athletes. A neuropathological severity staging system has been developed based on lesion complexity.

6699 Primary Hyperparathyroidism With Severe Hypercalcemia Secondary to Giant Parathyroid Adenoma

Abstract Disclosure: M.P. Lieberman-Ulm: None. M.A. Yanez-Bello: None. V.S. Lagari-Libhaber: None. Background: Parathyroid adenomas are often detected in asymptomatic patients without palpable neck mass and are responsible for 80 to 85% of cases of primary hyperparathyroidism. Oversized or “Giant” parathyroid adenomas (GPAs) are defined as parathyroid adenomas that weigh more than 3.5 g. These are rare, representing less than 1.5% of parathyroid adenomas. The majority of reported cases of GPAs are associated with elevation of PTH and calcium levels, though usually not as high as is seen in patients with parathyroid carcinoma, where PTH levels typically reach greater than three times the upper limit of normal and serum calcium greater than 14 mg/dL. Clinical Case: A 73-year-old man presented with altered mental status and was found to have severe hypercalcemia (serum calcium 20.5 mg/dL, albumin 4.4 g/dL) and AKI stage III (eGFR 16 mL/min/1.73m2). Physical exam showed palpable, mobile, left-sided fullness, and further lab evaluation revealed intact PTH of 2,934 pg/mL, vitamin D, 25-OH of 24.8 ng/mL, and PTHrP of 14 ng/mL. Phosphorous level was not collected prior to treatment. Neck ultrasound was unremarkable. CT revealed a 9 cm hypodense lesion inseparable from the posterior aspect of the left thyroid lobe extending inferiorly to the posterior mediastinum at the level of the carina. Sestamibi scan showed scintigraphic evidence of parathyroid adenoma in the left tracheoesophageal groove. Patient was treated with IV fluids, zoledronic acid, calcitonin, cinacalcet and furosemide in addition to receiving hemodialysis on arrival. He then underwent resection of the mediastinal parathyroid gland. Pathology revealed parathyroid adenoma (16.6 g) without evidence of gross or microscopic invasion into adjacent structures, vascular or perineural invasion. Size greater than 3.5 g classified this mass as a giant parathyroid adenoma. Post-operatively, the patient’s PTH and corrected calcium normalized (17 pg/mL and 9.4 mg/dL, respectively). Conclusion: Giant parathyroid adenomas are a rare cause of primary hyperparathyroidism. Generally, parathyroid adenomas present with less severe clinical and biochemical characteristics than those of parathyroid carcinomas. However, the characteristics of GPA can be similar to parathyroid carcinoma, and differentiating between the two can be challenging. Parathyroid masses are differentiated with histologic diagnosis along with haematoxylin and eosin stain findings. In the case of our patient, his clinical picture was suggestive of parathyroid carcinoma given the severity of his disease, but pathology revealed parathyroid adenoma. Additionally, his calcium and PTH levels normalized after parathyroidectomy. This case may be representative of rare, aggressive giant parathyroid adenoma, however close follow up is imperative to ensure patient does not develop metastatic disease in the future, which would suggest underlying malignancy all along. Presentation: 6/2/2024

12338 Risk Of Retinopathy In Patients With Type 2 Diabetes On Semaglutide

Abstract Disclosure: A. Gupta: None. M. Nassar: None. H. Ghanim: None. Title: Risk of Retinopathy in Patients with Type 2 Diabetes on SemaglutideBackground: The use of semaglutide in patients with diabetic retinopathy (DR) has raised safety concerns. While previous studies, including a meta-analysis and the SUSTAIN trial, suggested an association between rapid HbA1c reduction and retinopathy progression, recent data question the increased risk with semaglutide. Our study investigates this risk of intensive therapy benefits for the prevention of DR. Methods: This retrospective cohort study utilized TriNetX electronic health records, analyzing 117,693,426 patients with type 2 diabetes mellitus (T2DM) on anti-hyperglycemic drugs. We divided patients into those with and without a history of retinopathy, further subdividing them by treatment (Semaglutide, Sitagliptin, and Empagliflozin). After matching for confounders, we analyzed the incidence and progression of retinopathy among 336,338 Semaglutide, 578,117 Sitagliptin, and 434,552 Empagliflozin patients without a history of DR, as well as a cohort with history. Results: In patients without a prior history of DR, semaglutide showed a significant reduction in DR incidence over three years compared to sitagliptin and empagliflozin (p&amp;lt;0.0001). However, in those with a history, the reduction was not statistically significant (p &amp;gt; 0.05). Patients with mild DR on Semaglutide experienced fewer progressions to severe stages (p&amp;lt;0.0001), while outcomes in severe cases were inconclusive.Discussion: Semaglutide may lower the risk of developing DR in patients with T2DM without a prior history of DR and potentially stabilize or improve mild conditions without worsening severe retinopathy. The observed effects could influence treatment choices, emphasizing the need for individualized patient management. Conclusion: Semaglutide appears safe regarding retinopathy risk in patients with T2DM, offering protective benefits in those without history and not exacerbating conditions in those with prior DR. This underscores the drug's potential for comprehensive diabetes management without compromising ocular health. Presentation: 6/3/2024

Process-Specific Blood Biomarkers and Outcomes in COVID-19 Versus Non-COVID-19 ARDS (APEL-COVID Study): A Prospective, Observational Cohort Study.

Background: Severe acute respiratory syndrome (SARS) and acute respiratory distress syndrome (ARDS) are often considered separate clinico-radiological entities. Whether these conditions also present a single process-specific systemic biomolecular phenotype and how this relates to patient outcomes remains unknown. A prospective cohort study was conducted, including adult patients admitted to the ICU and general floors for COVID-19-related (COVID+) or non-COVID-19-related (COVID-) acute respiratory failure during the main phase of the pandemic. The primary objective was to study blood biomarkers and outcomes among different groups and severity subsets. Results: A total of 132 patients were included, as follows: 67 COVID+, 54 COVID- (with 11 matched control subjects for biomarker reference), and 58 of these patients allowed for further pre- and post-analysis. The baseline apelin (APL) levels were higher in COVID+ patients (p < 0.0001 vs. COVID- patients) and in SARS COVID+ patients (p ≤ 0.02 vs. ARDS), while the IL-6 levels were higher in ARDS COVID- patients (p ≤ 0.0001 vs. SARS). Multivariable logistic regression analyses with cohort biomarkers and outcome parameters revealed the following: (i) log-transformed neprilysin (NEP) activity was significantly higher in COVID+ patients (1.11 [95% CI: 0.4-1.9] vs. 0.37 [95% CI: 0.1-0.8], fold change (FC): 1.43 [95% CI: 1.04-1.97], p = 0.029) and in SARS patients (FC: 1.65 [95% CI: 1.05-2.6], p = 0.032 vs. non-SARS COVID+ patients, and 1.73 [95% CI: 1.19-2.5], p = 0.005 vs. ARDS COVID- patients) and (ii) higher lysyl oxidase (LOX) activity and APL levels were respectively associated with death and a shorter length of hospital stay in SARS COVID+ patients (Odds Ratios (OR): 1.01 [1.00-1.02], p = 0.05, and OR: -0.007 [-0.013-0.0001], p = 0.048). Conclusion: Process-specific blood biomarkers exhibited distinct profiles between COVID+ and COVID- patients, and across stages of severity. NEP and LOX activities, as well as APL levels, are particularly linked to COVID+ patients and their outcomes (ClinicalTrials.gov Identifier: NCT04632732).

A-117 Discordance of CKD stage assignment by different Western and Asian estimated GFR formulae in patients of Eastern India

Abstract Background Chronic Kidney Disease (CKD) Stage based on estimated GFR governs the decision between treatment choices eg dialysis, transplant etc. There is no customized eGFR formula for Indians, and hardly any data is available regarding concordance between CKD staging by various formulae on Indian population. The CKD-EPI-Pakistan formula, developed through a collaboration involving original authors of MDRD/CKD-EPI, is the Asian formula ethno-geographically closest to India. However it has not been tested on Indians. Methods We compared 4 eGFR formulae: MDRD(4-factor), CKD-EPI-2009, and CKD-EPI-2021-Creatinine and CKD-EPI-Pakistan for 126 patients undergoing kidney function testing in a tertiary care center in Eastern India. Input for race was non-black in all. Results Thirty six of 126 (29%) were discordant by 1 stage between 1 or more formula-pairs, and Kendall's W was 0.034366339 suggesting weak concordance. Among the MDRD CKD3b and CKD4 cases, CKD-EPI Pakistan re-classified 12% by one stage higher. In the same cases, CKD-EPI-2009 and 2021 both assigned 1 stage lower than MDRD in about 18% and 35% respectively. For MDRD-CKD3a cases too CKD-Epi-Pakistan predicted one stage higher in 50%, whereas both CKD-EPI-2009 and 2021 gave one stage lower in 25%. CKD5 staging were mutually concordant, except Pak formula giving 66% more CKD5. Conclusions There is a significant under-staging of CKD stages of Indian patients using western CKD-EPI equations compared to MDRD, whereas CKD-EPI-Pakistan over-stages them especially in the severe stages. If Asian CKD-EPI-Pakistan is considered biologically appropriate for Indians, about 20-30% of treatment-needing patients might currently be under-classified and denied life-saving treatment modalities e.g. Dialysis/CRRT/Transplant, and it might become worse if CKD-EPI 2009 or 2021 is adapted instead of MDRD, especially for higher CKD Grades. The mutual discordance highlights urgent need of having formulae customized for Indian population validated over a large number of patients locally using measured GFR.

Evolution of Nutritional Status in Patients on Hemodialysis after 1 Year of Intervention by a Team of Kidney Dietitian-Nutritionists: Is It Possible to Correct Malnutrition from More Severe Stages?

Evolution of Nutritional Status in Patients on Hemodialysis after 1 Year of Intervention by a Team of Kidney Dietitian-Nutritionists: Is It Possible to Correct Malnutrition from More Severe Stages?

Protective Factors Associated With Lower Likelihood of Injection Drug Use and Experiencing Overdose Among Incarcerated Women

PurposePrior studies evaluated protective factors individually as they relate to fewer drug use risk behaviors and related consequences. This is the first study to examine protective factors as part of a multilevel framework along a risk continuum among women involved in the criminal legal system who use drugs. This study describes factors within the socio-ecological framework that are protective against engaging in injection drug use and experiencing nonfatal overdose. MethodData were collected from 900 women with a history of opioid use disorder who were incarcerated and enrolled in the National Institutes of Health/National Institute on Drug Abuse–funded Justice Community Opioid Innovation Network cooperative. Analysis focused on the relationship among individual, interpersonal, and community- or institutional-level protective factors associated with not injecting drugs and not experiencing an overdose in the 90 days before incarceration using multinomial logistic regression. FindingsFindings from this study suggest that, even among a sample of women who use drugs, there are a number of factors associated with being less likely to report higher-risk injection behavior and/or overdose experiences at the individual level (age, religiosity, and less polysubstance use), interpersonal level (not having a partner who injects drugs), and community or institutional level (fewer months incarcerated, less treatment utilization, and less enacted stigma by health care workers). ConclusionsFindings from this study underscore the importance of being able to target prevention interventions to women at different stages of substance use severity and to capitalize on protective factors for those at lower-risk levels to reduce the trajectory of risk to injection practices and overdose experiences.

Satellite based analysis of rapid intensification of Super Cyclone Amphan

Tropical Cyclones (TCs) are formidable natural hazards with destructive impacts on life and property along the tropical belt. TCs are responsible for multiple hazards such as riverine and urban floods, extreme winds, and lightning, storm surge significantly amplifying the threats they pose. Rapid Intensification (RI), defined as a sudden increase in Maximum Sustained Winds (MSWs) by 30 kt or more in 24 h, has been a growing concern. These events, characterized by a swift escalation in MSW are challenging to the forecasters and remain a considerable operational challenge, amplifying risks for coastal communities. Numerical modeling also struggles to predict RI, with limitations in describing inner core convective scale processes cited as a major limitation. Monitoring and assessing TCs heavily rely on satellite-based observations due to the absence of adequate in-situ measurements over the ocean. In the present study, we examine Super Cyclonic Storm (SuCS) Amphan, the first Super Cyclone of this century, that formed over the Bay of Bengal in 2020 using satellite imagery and derived products available in near-real time to monitor and identify the early signatures for the RI. It is observed that the intensification is intricately tied to substantial expansions in both the outer and inner core sizes along with its symmetricity before the RI. Notably, no significant alterations in size are observed between the very severe cyclonic storm (VSCS) and SuCS stages. The convection characteristics of TCs are found to provide crucial markers of their intensification, with a particular emphasis on polar satellite-based passive microwave imagery for analyzing embedded convection and early eye detection. Key observations indicate that inner convective ring patterns, identified through 37Ghz microwave imagery in lower-level convection, act as precursors to rapid intensification. Concurrently, the outer ring pattern observed during the mid-life course is found to permit further intensification of the system.

Mid- and long-term renal outcomes after metabolic surgery in a multi-center, multi-ethnic Asian cohort with T2DM

ABSTRACT Background Metabolic surgery is recognized for its effectiveness in weight loss and improving outcomes for individuals with type 2 diabetes mellitus (T2DM). However, its impact on renal function, especially in multi-ethnic Asian populations, remains underexplored. This study investigates mid- and long-term renal outcomes following metabolic surgery in Asian patients with T2DM. Methods This retrospective cohort study utilized data from the Asian Diabetes Surgery Study (ADSS), involving T2DM patients aged 20–79 who underwent metabolic surgery from 2008 to 2015. The primary outcome was the change in estimated glomerular filtration rate (eGFR) at 1, 3, and 5 years post-surgery, with adjustments for confounders. Secondary outcomes included changes in chronic kidney disease (CKD) stages and the relationship between weight loss and eGFR changes. Data were analyzed using univariate and multivariable regression analyses, along with the McNemar test. Results The study included 1513 patients with a mean age of 42.7 years. The results revealed that a significant improvement in eGFR was observed at 1-year post-surgery (112.4 ± 32.0 ml/min/1.73 m², P &amp;lt; .001), with a shift toward less severe CKD stages. However, this improvement was not sustained at 3 and 5 years. No significant correlation was found between weight loss and eGFR changes at 1-year follow-up. Conclusion Metabolic surgery significantly improves renal function at 1 year postoperatively in Asian individuals with T2DM, highlighting its potential benefits beyond glycemic control and weight loss. The long-term effects on renal function require further investigation.

Research on multi-source information fusion tool wear monitoring based on MKW-GPR model

To enhance intelligent manufacturing capabilities and achieve the goal of online real-time high-precision monitoring of tool wear with small sample data, this paper proposes a multi-source information fusion method for turning tool wear monitoring based on the multi-kernel weighted Gaussian process regression (MKW-GPR) model. Firstly, the framework and process of multi-source information fusion for turning tool wear monitoring are established, and the experimental platform is constructed. Secondly, a full-life cutting experiment of the turning tool is conducted. During the experiment, tool wear image data and multi-sensor signal data, including cutting force and vibration signals, are collected. Then, the experimental data were processed to construct a dataset with multi-source information fusion, leading to the establishment of the MKW-GPR model. Subsequently, the experimental dataset was employed to validate the effectiveness of the turning tool wear monitoring model. The results demonstrate that, in recognizing the wear state, the MKW-GPR model exhibited superior recognition performance compared to the single kernel function Gaussian process regression model. Furthermore, in predicting the wear value, the MKW-GPR model is better than the long short-term memory (LSTM), random forest (RF), and scalable end-to-end tree boosting (XGBoost) models. During the small sample size priori point data prediction performance test, the MKW-GPR model achieved the highest accuracy, with a maximum relative error of only 2.8 % in predicting tool life during the severe wear stage. These findings substantiate the feasibility and effectiveness of the proposed turning tool wear monitoring method.

Randomized controlled trial of frailty and disease stage in older people living with Chronic Kidney Disease

IntroductionThe GOAL trial, a cluster-randomised controlled trial, investigated the effect of comprehensive geriatric assessment (CGA) on frail older people with chronic kidney disease (CKD). This paper describes (1) participant baseline characteristics, and (2) their relationship with CKD stage and frailty severity. MethodsSixteen kidney outpatient clinics (clusters) were randomly allocated 1:1 to CGA or usual care. Enrolled frail older people with CKD (Frailty Index >0.25; aged ≥65 years or ≥55 if First Nations people) received the intervention allocated to their cluster. CKD was defined as moderate (stages 3/4) or severe (stage 5/5D), and frailty categorised as moderate (>0.25 to <0.36), severe (0.36 to <0.45) or very severe (≥0.45). Participant characteristics were analysed using descriptive statistics. Statistical methods appropriate for type of outcome were used to describe the association of frailty and CKD categories with participant characteristics. ResultsOver a 27-month period, 240 people were recruited (55.7% male, 82.9% white/European). Mean age was 76.9 (SD: 6.6) and median FI was 0.39 (IQR: 0.32 – 0.47). The median EQ-5D-5L quality of life index score was worse in those with very severe frailty (0.57, IQR: 0.28 – 0.83) compared to severe frailty (0.85, IQR: 0.67 – 0.92) and moderate frailty (0.90, IQR: 0.82 – 0.93) (overall P <0.001). Median EQ-5D-5L was also worse in those with severe CKD (0.79, IQR: 0.40 – 0.89), compared to moderate CKD (median 0.87, IQR: 0.73 – 0.92; P 0.001). ConclusionThis cohort demonstrated poorer quality of life scores in those with more severe frailty and more advanced CKD.